Tea Nguyen, DPM (00:53.88)

This is the last of the three-part series that I put together to help you build a profitable direct specialty care practice. And it happens to land during the same time that I just celebrated, eight years in private practice. So, just to recap what we've gotten so far, in the first episode, I talked about building a signature offer. This is the thing that you sell. This is how you create it, how you frame it, how you have conversations about what you offer.

What does it cost? Then navigating those very awkward money conversations with patients. The second episode was now that you have an offer, now that you have a thing to sell, now that you've packaged it appropriately for a direct care practice, you've got to find people who want to buy it. And I offered my experience as to where the best return on investment is, ranking it from best and most cost effective.

To what's more expensive, but you gotta do it with a strategy so that you're not throwing it at a machine hoping for it to work. We don't work on hope. We work with the strategy. And today I'm going to share with you the evolution of my practice over the past eight years and really just to show you the evidence that you don't have to have it all figured out. None of us do. What you think your practice is going to look like today is not going to look exactly the same.

10 years from now. Most of the doctors who I've interviewed on this podcast and those who I've had private conversations with all say the same thing. They did not have it all figured out. And the ones who are most successful are the ones who move quickly when things go off script, when things come up unexpected. All you really need to do is to be willing to move forward. And it provided you with the foundation of what already works. So you're going to be a step ahead than many of us who didn't have this.

Luxury who didn't have the resources of AI, of the internet, of the podcast, of all of the resources we have here. So realize you're already in a very good place simply by being here on this podcast. So I want to give you a quick overview of my personal experience in building my practice so that you can have a framework or an understanding of my lens in how I'm sharing what actually works for direct care.

Tea Nguyen, DPM (03:14.348)

Back in twenty eighteen, around January, I was still employed. I was in practice. They were doing financially well. I got a check every two weeks. Patients were on my schedule. The staff and the systems were in place. I didn't really have to do that much to get a paycheck. But I had to sacrifice quite a bit in order to have that comfort. I had to give up my autonomy. I had to do what was expected of me as an employee. And it just wasn't really working out.

Because I also was pregnant at the time. Move forward into June of 2018. I had my baby girl, and there was always a curiosity in the back of my mind saying, "Can I do this myself? How do I do this? Other people are able to do it, why not me? And so when I had my daughter, I was already making plans to open my own practice, which was scheduled for as soon as possible. So I had my daughter in June.

I was working through what my dream practice would actually look like. And I started hiring in July and I opened the doors in August to see my first patient. Now I was fully unprepared for doing any of this, but when you don't have a lot of options, you get really crafty, you get really creative, you get really resourceful. And that's exactly what I did. I didn't have a mentor to tell me you should do a direct care practice. Nobody was saying that at the time. Everybody said get on all of the insurance contracts and you'll be fine.

So I did that. So I was in the honeymoon phase between the day I opened in August for the rest of the year. Come 2019, I was trying to figure out my expenses and the money coming in. Like how do I sort this out while paying my two full-time employees with benefits, chasing down billing codes, going to conferences, trying to learn how to bill appropriately, learning new modifiers, understanding that there were circumstances that I had to be aware of.

That affected my revenue. For example, if I provided a consultation on the same day as a procedure, my procedure would get discounted or not covered at all. So I was learning a lot of things on the fly and it was very frustrating. At first I thought, okay, I know that this was going to be hard because I pushed through, but eventually you carry so much weight that each step you take felt tremendously difficult. What seemed very simple got extremely hard. So by the end of 2019,

Tea Nguyen, DPM (05:35.766)

I was suffering. I was struggling financially. Bills could not be paid. It was the first time in my life where I had a credit card bill that I could not pay off monthly. And so each month that passed, the interest rate of twenty, twenty-five percent of the balance was adding up. And I was mortified. I did not have a backup plan. I did not have anything else in my savings account because I put it all into my practice here. And so I sought out professional help and they all said the same thing. See more patients. And

I had this kid who is growing in my office, no more capacity, no more bandwidth, no more energy, no more joy in running my practice. But I had to figure it out because I had a lot of bills to pay off at this time. So come 2020, remember 2020, the start of the pandemic, we shut down in March, could not do elective surgeries. I had to pivot and learn a new skill to deliver medical care.

Surgical care and my practice set up a surgical suite and all of that. Honestly, I was like, this has got to be the worst time for our economy. And my practice is not thriving. What's the worst that can actually happen if I dropped my biggest payer that was also giving me the most headache? So by April 2020, I dropped Medicare without a plan. And that was totally insane because that was about 50, 60% of my total revenue.

But it also required me to work so hard for so little. But I knew I had to do something. And I was so uncertain about what was going to come next. Now, fast forward a little bit into 2022. Now that I got the hang of what it's like to opt out and what it takes to refresh my funnel or get new patients into the practice, the last insurance, I could have stayed with it. It paid okay, but it still required me to know billing codes and go through the EMAR process of sending out the claims and

Understanding deductibles, collecting copay, all the things, right? All the stuff that is very distracting from patient care. I finally said, you know what, I went through the hardest thing already. What's the worst that can happen if I just opted out of all insurances in this phase? So that was in 2022. I remember this in September. I was panicking, I was freaking out, but I did it anyway, even though I didn't have a plan. So now we're four years past that. It's 2026. And I get to sit here with you today.

Tea Nguyen, DPM (07:59.028)

And share with you, I'm celebrating my eighth year in private practice, completely independent of insurance. And I did not plan for any of this to happen. I actually didn't plan on having a kid. I didn't plan on opening my practice. I didn't plan on dropping insurances. And I certainly didn't plan for the pandemic. So all that to say is you're in a better position than I was, because now you've got a plan. You know exactly what needs to happen because you listen to the podcast. There were some other things that came up.

Unplanned in 2026. And I know a lot of you have been with me since the beginning of the podcast, and even before that, when you just knew me as T. And so I want to share this with you. In early 2026, we declared, my husband and I, that we were going to file for divorce. And I feel like this is important to frame and to share because there is life outside of our business, our clinic walls.

And it often shapes the decisions we make within the business. Marriage has given me a prescriptive path. We romanticize what life is supposed to look like, right? You get a job, you get married, you have kids, you buy a house. It's an American dream, right? But sometimes reality is not congruent with what you truly desire. Now I have no ill feelings about the situation. This is a learning experience for me.

And it gave me a really solid foundation of what a healthy partnership really is throughout and even afterwards. What he said in my therapist's office as we were making this decision together is that this was a really good movie that simply had an ending. And a lot of the decisions I made, building my practice, was framed around having a financially stable marriage. So I want you to understand that.

I did have a financial pathway as I built my practice. And I encourage you to find a financial pathway as you build it, because it is going to take time to build up a new set of patients and your revenue. And I've talked about this at other lectures where you either need to have a second job, savings account, or marry rich. And I still stand by that. You need to have money to fund your life. So this was another one of those things that I didn't plan for. And now I have to navigate it.

Tea Nguyen, DPM (10:18.392)

So the future is truly and I I want to say this with love, but also with a dash of reality. You have to get over the idea of having to control every facet of your life, every facet of your business. You cannot control many things. You cannot control the outcomes. You may think it's gonna go one way, but reality is going to humble you and it will say to you, it will show you that no, how you thought it was going to go down is not what's actually going to happen.

So you gotta get over the idea of controlling everything and trying to predict the future. Now we can mitigate, we can have a plan, but we also need to be flexible about how we move towards our goal. A second thing that came up this year was the space that I leased, the building suddenly went up for sale. And this period of time, I had this crushing fear and anxiety about what is going to happen to my practice. And I just remember totally crashing out.

Driving to work, seeing the for sale sign of the building, and thinking about all of the what-ifs. What if I have to move my practice? Where would I go? Do I actually want to stay in this town? Do I wanna continue on this trajectory of my private practice? How am I gonna support myself with this new shift and change in my life? What's the backup plan? So in true T fashion, I did a thing.

I decided to throw a little bit more chaos in there and throw a taco truck party because doing something makes me feel better than sitting around ruminating. And also when I do things in community, I find that it puts things in perspective for me instead of letting the craziness in my mind take over. So that's what I decided. I didn't know if the date I set was secure. I didn't know if I would still be in the office. So there was a few months in preparation for this.

And I did it anyway. We pushed through and I did it in collaboration with other healthcare professionals in my community who were new to me or who have referred to me, vice versa. We shared patience and it ended up being a really successful event. So as of today of this recording, I'm still in my current office space. The taco party was really fun. And I'm accepting that overthinking is a mental prison. You cannot control the outcome, but you can shape.

Tea Nguyen, DPM (12:41.73)

your current experiences, try to have fun with it by reframing what your reality is and being present to what's needed today. Not down the road, but today. What needs to happen today. Now I do want to share there's a lot of benefits to putting together a community event like this. It's not a lot of work per se. You just you pay the taco person, you set up some tables and you send out invitations. That's really all that it was.

And everyone's got an iPhone. So if you want to have pictures, you can have people take pictures, ask for their assistance. But I did not overplan this at all. And because I co-hosted this, everybody pitched in money, I ended up not spending all that much on the event. And I got to reconnect with existing referral patterns and I got to talk to prospective patients. And I think that's really cool. That is how you get visibility and tacos. So if you haven't done it yet, consider it. Three things that happen.

Number one, you get more visible, right? You heard me say that. Number two, you connect with your community, which I think is incredibly valuable for small businesses. And number three, there's food. This is a love language. People connect over food. People appreciate it. It is really fun. Now back in 2018, did I think I would still be here in practice in this new office, throwing a party and running a business without insurance? No, no way. That did not cross my mind until it did.

So here's the one thing for you to take away from this series, this episode. If you get started building your practice today, you will get to where you want to be faster. The more you delay in making a decision, the more you prolong your inevitable success. You will be successful. But when is a matter of when you decide to start? Now you don't have to have it all figured out. Most of us don't have it figured out.

But you just need to start with one foot in front of the other. Your efforts will compound over time. And yes, that was a pun from a podiatrist. It is totally intended. One foot in front of the other. So now you've got these three episodes, which is the framework to building a sustainable direct specialty care practice. First, have a great offer people are willing to pay for. Have those awkward money conversations with lots and lots of people. And number two, get lots and lots of people to know what you do and where you are.

Tea Nguyen, DPM (15:06.496)

And number three, realizing that you don't have to have it all figured out and that you will evolve to become the person who can run a successful direct care practice. And the thing is, knowing is simply not enough. You have to do the work, apply the concepts, and learn through experience. It's just like medical school. The textbook learning is very different from real life applications. And that's where coaching is the practical where you don't have to figure it all out by yourself.

The path is already there. So if you're new to business ownership, this is like residency where you will have someone alongside you guiding you to stay on course where you can learn from someone's experience and reduce those costly mistakes. So if that's you and you're interested in working with me, I put together a direct care readiness assessment to help you gauge where you're at. I will review it with you and we can talk about your next steps. Did you see what I did there?

We're gonna talk about it. All right, so there's no obligation in this. I just wanna make sure that you are clear about what needs to happen next for you. I do take on these calls personally. It's not an AI agent or anything. And I'm really looking forward to connecting with you in real time. I hope you enjoyed this series. I hope it's given you the foundation as to what needs to happen for you. And if you need more, follow the links in the show notes. And I will catch you next week. Thanks so much for being here. Take care.